BCRG (Birmingham Cardio-Renal Group)

The original Chronic Renal Impairment in Birmingham (CRIB) study was published in 2003, documenting the relative lack of importance of traditional risk factors in CKD. Since this the BCRG have demonstrated abnormalities of vascular and ventricular function in patients with early stage CKD and gone on to design potential therapeutic strategies. In the randomised controlled trial CRIB-2, we investigated the effect of treatment with spironolactone, a mineralocorticoid receptor blocker (MRB), in combination with ACE inhibitors and or angiotensin receptor blockers in patients with early stage CKD. Previously considered to be contra-indicated in CKD, spironolactone was shown to improve prognostically important indices including arterial stiffness and left ventricular (LV) mass with improvement in markers of LV diastolic and systolic function. 

1. Spiro-CKD
   
   The SPIRO-CKD trial of spironolactone versus chlorthalidone in early stage CKD has been awarded a British Heart Foundation special project grant. The multi-centre study led by the BCRG should demonstrate the effects of mineralocorticoid receptor antagonist therapy on LV mass and arterial stiffness in this population, independent of changes in blood pressure. The study has completed recruitment and results are expected in 2019.
   
   
2. CKD-Fibrosis
   
   CKD-Fibrosis has been awarded a project grant from the British Heart Foundation and uses the very latest in cardiac MRI sequences to elucidate the role of myocardial fibrosis in the pathogenesis of CKD-related heart failure and sudden death. We have completed recruitment for this study and results are expected in 2019. 
   
   
3. CRIB-DONOR II
   
   

   Kidney donors provide a unique population without underlying disease and this allows the longitudinal study of an isolated reduction in renal function on the heart and vasculature. A comprehensive pathophysiological study of living kidney donors was previously funded by a British Heart Foundation Fellowship (CRIB-DONOR). The results indicate that living kidney donors have a small increase in left ventricular mass post nephrectomy. We have been recently awarded a second British Heart Foundation Fellowship to follow these patients up again after five years. Recruitment is underway and due to finish in 2019.

4. EARNEST
   
   Meanwhile, a less detailed but larger scale UK multi-centre study (EARNEST) of kidney donors has also received a project grant from the British Heart Foundation and involves a number of other UK transplant centres including Cambridge, Glasgow, Bristol, Manchester, Sheffield, St George’s London and Coventry. Over 400 patients have been recruited. Provisional results are anticipated in the next few months.
   
   
5. RETRACT
   
   

   Kidney transplantation is the most effective treatment for patients with advanced kidney disease and is associated with an improvement in cardiovascular outcomes for patients. We have recently been awarded a British Heart Foundation Fellowship to investigate the effects of kidney transplantation on the heart using specialised MRI techniques. Recruitment commenced in December 2018.

• Vive les Differences! - A case for optimism in the treatment of patients with heart failure and preserved ejection
  fraction? Law JP, Pickup L, Townend JN, Ferro CJ. Int J Clin Pract. 2018 Dec 23:e13307. doi: 10.1111/ijcp.13307.
• Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors. Price AM, Edwards NC, Hayer MK, Moody WE, Steeds RP, Ferro CJ, Townend JN. J Am Soc Hypertens. 2018 Jul;12(7):497-505.e4. doi: 10.1016/j.jash.2018.04.010. Epub 2018 May 9. Review.
• Diffuse Myocardial Interstitial Fibrosis and Dysfunction in Early Chronic Kidney Disease. Hayer MK, Price AM, Liu B, Baig S, Ferro CJ, Townend JN, Steeds RP, Edwards NC. Am J Cardiol. 2018 Mar 1;121(5):656-660. doi: 10.1016/j.amjcard.2017.11.041. Epub 2017 Dec 11.
• Premature coronary artery disease and early stage chronic kidney disease. Price AM, Ferro CJ, Hayer MK, Steeds RP, Edwards NC, Townend JN. QJM. 2018 Oct 1;111(10):683-686. doi: 10.1093/qjmed/hcx179. Review.

For full list of publications:

• Jonathan N Townend 
• Charles J Ferro 
• Richard P Steeds 

Principal Investigators

• Professor Jonathan N Townend, Associate Professor - Director of Clinical Research 
• Professor Charles J Ferro, Honorary Reader in Nephrology and Consultant Nephrologist
• Professor Richard P Steeds, Professor of Cardiovascular Medicine and Consultant in Cardiovascular Imaging
• Dr Davor Pavlovic, Associate Professor in Cardiovascular Sciences
• Professor Melanie Madhani, Professor in Cardiovascular Medicine

PhD Students and Clinical Research Fellows

• Dr Anna M Price, Clinical Research Fellow and Spr in Nephrology 
• Dr Luke C Pickup, Clinical Research Fellow and SpR in Cardiology
• Dr Ashwin Radhakrishnan, Clinical Research Fellow and SpR in Cardiology
• Dr Jonathan P Law, Clinical Research Fellow and SpR in Nephrology

Former Group Members

• Dr Manvir K Hayer, SpR in Nephrology
• Dr Khai Ng, SpR in Nephrology
• Dr William E Moody, Consultant Cardiologist with an Interest in Cardiac Imaging
• Dr Colin D Chue, Consultant Cardiologist with an Interest in Heart Failure
• Dr Nicola C Edwards, Honorary Senior Research Fellow and Consultant Cardiologist with an Interest in Cardiac Imaging
• Dr Victoria Stoll, Clinical lecturer and SpR in Cardiology